Abstract

Background: Best medical therapy (BMT), encompassing anti-platelets, statins, smoking cessation, blood pressure and glycaemic control, is a cornerstone of peripheral arterial disease (PAD) management. However, a prospective audit of general practitioner (GP) referrals for suspected PAD demonstrated these modifiable risk factors are often left unaddressed by primary care while patients await vascular clinic. Methods: A prospective audit of electronic GP referrals to the vascular department for symptomatic PAD between July 2021 and June 2022 was performed. As part of an education initiative, information leaflets on BMT were posted to all GP practices in the Saolta region. Subsequently, the clinic outcomes of the first cycle referrals were reviewed to determine the safety of suggesting GPs start BMT prior to vascular assessment. Results: One-hundred-and-seventy suspected PAD referrals were analysed as part of the first audit cycle. At the time of referral, twenty-eight percent (n=33) were active smokers and only 34.5% (n=40) and 52% (n=60) were on anti-platelets and statins, respectively. By July 2023, 38% (n=65) patients had been seen in outpatient department (OPD). Sixty-nine percent were confirmed to have PAD by a vascular surgeon. Medications were adjusted in 22 referrals to reflect BMT. Clinic outcomes included admission for revascularisation (n=2), urgent imaging (n=7), continue BMT and surveillance (n=36) and discharge without vascular pathology (n=17). Conclusions: Our first-cycle results identified significant scope for improvement in community-based risk factor modification for PAD referrals. A review of subsequent clinic outcomes suggests that is it reasonable for GPs to start BMT prior to vascular surgery review.